Utilisation rates and expenditure for public and private, curative-care services in semi-urban Guatemala

In November 1994, a retrospective survey was conducted for two purposes; to investigate patterns of health-care uptake for childhood and maternal illness in semi-urban Guatemala; and to gain an insight into the expenditure incurred by the subjects when they consulted the various health-care providers. The subjects, who all belonged to a semi-urban ladina community, had easy geographical access to the health-care providers, of all types, operating in Sacatepequez, in the central highlands of Guatemala. The community was divided into clusters of roughly equal population size and 20 of these were selected. Within each selected cluster, eight households that had at least one young child (< 5 years of age) were investigated. Mothers belonging to each household were asked whether, how frequently, and where they had sought outside help for any health problem that had possibly affected them or their children during the past year. Subsequently, they were also invited to recall the expenditure incurred on the last visit, if any, to each type of health-care provider established in the area. The crude utilisation rates, for all providers combined, were 1.0/women.year and 0.8/child.year. Overall, 61% of women had no uptake of curative care for themselves and 12% of families no such uptake for their children. Lay curers and clinics run by non-governmental organizations were hardly utilised. Drug vendors accounted for 38% of contacts by women and 26% by children, private physicians for 34% and 38%, and public services for 22% and 33%, respectively. The utilisation rate of the official sector attained roughly 0.3/person.year in both women and children. Dissatisfaction with the treatment received and the lack of drugs were often given as reasons for not attending public services. The median total expenditure incurred per curative, health-care contact ranged from 0 quetzales in the official health centres to 63 quetzales with private physicians (a U.S.$ being equivalent to 5.5 quetzales at the time of the study). Although for each type of provider (except the health centres), expenditure was nearly equal for a woman or for a child contact, it consisted of a different mix of cost elements (consultation fee, drugs and transport) for each of the various categories of provider. The willingness for a more prominent role of the public sector. It would seem that there is, in the socio-economic environment of semi-urban Sacatepequez, room for experimenting with alternative modes of health-care financing to increase the quality and attractiveness of public services and their utilisation.